Overview In medical terms, a bunion, or hallux valgus, is a bony bump that forms around the joint at the base of your big toe. This joint is one of the most important parts of your foot, bearing most of your body weight. The bony bump is caused by the head of the first metatarsal bone (the long bone) behind the big toe angling out from the foot. This causes the joint to swell, pushing the big toe in towards the adjacent toes. The result is pain on the side of your foot, arch pain, and discomfort throughout the adjacent toes as well.

Causes
By far the most common cause of bunions is the prolonged wearing of poorly fitting shoes, usually shoes with a narrow, pointed toe box that squeezes the toes into an unnatural position. Bunions also may be caused by arthritis or polio. Heredity often plays a role in bunion formation. But these causes account for only a small percentage of bunions. A study by the American Orthopaedic Foot and Ankle Society found that 88 percent of women in the U.S. wear shoes that are too small and 55 percent have bunions. Not surprisingly, bunions are nine times more common in women than men.

Symptoms
Redness, swelling, or pain along the inside margin of the foot just behind the great toe. Moderate to severe discomfort at the bunion when wearing shoes, particularly if tight fitting. A painful callus may develop over the bunion. Sometimes a painful corn on the adjacent sides of the first and second toes. Irritation if there is overlapping of the first and second toes. Arthritis may cause stiffness and discomfort in the joint between the great toe and the first metatarsal. There may be a fluid filled cyst or bursa between the skin and the "bunion bone". Skin over the bunion may break down causing an ulceration, which can become infected.

Diagnosis
Bunions are readily apparent, you can see the prominence at the base of the big toe or side of the foot. However, to fully evaluate your condition, the Podiatrist may arrange for x-rays to be taken to determine the degree of the deformity and assess the changes that have occurred. Because bunions are progressive, they don't go away, and will usually get worse over time. But not all cases are alike, some bunions progress more rapidly than others. There is no clear-cut way to predict how fast a bunion will get worse. The severity of the bunion and the symptoms you have will help determine what treatment is recommended for you.

Non Surgical Treatment
Custom orthoses or over-the-counter insoles to aid big toe joint function, help control over-pronation and maintain proper alignment of the bones in the feet. Properly sized, supportive footwear that are torsionally stable (can?t be folded or twisted easily) and that feature a good ?rocker profile? (curved from the ball to tips of the toes) help to reduce stress on the joint when walking. Footwear modifications to expand the area of the shoe surrounding the bunion to relieve pressure. Physical therapy modalities include rest, icing and massage. Injections, surgery and other treatment options, please consult your medical doctor for information and/or referral to a podiatrist or other foot and ankle specialist.

Surgical Treatment
Bunion surgery involves realigning the joint into a better position. The procedure is usually performed under a general anaesthetic so the patient is not awake during the operation. A bunion causes a prominent bone over the inside of the joint between the foot and the big toe known as the 1st metatarso-phalangeal joint. It gives the appearance of the big toe pointing in towards the others. Surgery is a last resort treatment option in severe cases where walking or wearing shoes is painful.